Application for Planning Permission Town and Country Planning Act 1990

You can complete and submit this form electronically via the Planning Portal website by visiting www.planningportal.gov.uk/apply

Publication of applications on planning authority websites Please note that the information provided on this application form and in supporting documents may be published on the Authority's website. If you require any further clarification, please contact the Authority's planning department.

Please complete using block capitals and black ink. It is important that you read the accompanying guidance notes as incorrect completion will delay the processing of your application.

| 1. Applicant Name and Address | 2. Agent Name and Address | |-------------------------------|---------------------------| | **Title:** | **Title:** | | **First name:** | **First name:** | | **Last name:** | **Last name:** | | **Company (optional):** | **Company (optional):** | | **Unit:** | **Unit:** | | **House number:** | **House number:** | | **House suffix:** | **House suffix:** | | **House name:** | **House name:** | | **Address 1:** | **Address 1:** | | **Address 2:** | **Address 2:** | | **Address 3:** | **Address 3:** | | **Town:** | **Town:** | | **County:** | **County:** | | **Country:** | **Country:** | | **Postcode:** | **Postcode:** |

| 3. Description of the Proposal | |-------------------------------| | **SEE REF. 1A** | | **LOFT CONVERSION INCLUDING ALTERATION TO ROOF AND INSTALLATION OF ROOF LIGHTS.** | | **PREVIOUS APPLICATION FOR CHANGE OF USE OF PROPERTY FROM A (C3) DWELLING HOUSE TO A BED AND BREAKFAST (C1) PASSED 11.3.14 NP NO. NP/DDD/0112/005** | | **NO CHANGES TO GUEST ACCOMMODATION INCLUDED IN THIS PROPOSAL. RELEVANT TO OWNERS ACCOMMODATION ONLY** |

Has the building, work or change of use already started?\
☐ Yes ☒ No If Yes, please state the date when building, work or use were started (DD/MM/YYYY):

Has the building, work or change of use been completed?\
☐ Yes ☐ No If Yes, please state the date when the building, work or change of use was completed (DD/MM/YYYY):

Date: 2015-04-02 00:00:00 4. Site Address Details Please provide the full postal address of the application site.

Unit: [ ] House number: [ ] House suffix: [ ]

House name: [ ] Address 1: [ ] Address 2: [ ] Address 3: [ ]

Town: [ ] County: [ ] Postcode (optional): [ ]

Description of location or a grid reference: (must be completed if postcode is not known): Easting: [ ] Northing: [ ]

Description:

5. Pre-application Advice Has assistance or prior advice been sought from the local authority about this application? [ ] Yes [ ] No

If Yes, please complete the following information about the advice you were given. (This will help the authority to deal with this application more efficiently). Please tick if the full contact details are not known, and then complete as much as possible:

Officer name: [ ] Reference: [ ] Date (DD/MM/YYYY): [ ]

Details of pre-application advice received:

6. Pedestrian and Vehicle Access, Roads and Rights of Way Is a new or altered vehicle access proposed to or from the public highway? [ ] Yes [ ] No

Is a new or altered pedestrian access proposed to or from the public highway? [ ] Yes [ ] No

Are there any new public roads to be provided within the site? [ ] Yes [ ] No

Are there any new public rights of way to be provided within or adjacent to the site? [ ] Yes [ ] No

Do the proposals require any diversions/extinguishments and/or creation of rights of way? [ ] Yes [ ] No

If you answered Yes to any of the above questions, please show details on your plans/drawings and state the reference of the plan(s)/drawing(s):

7. Waste Storage and Collection Do the plans incorporate areas to store and aid the collection of waste? [ ] Yes [ ] No

If Yes, please provide details:

Have arrangements been made for the separate storage and collection of recyclable waste? [ ] Yes [ ] No

If Yes, please provide details:

8. Authority Employee / Member With respect to the Authority, I am: (a) a member of staff (b) an elected member (c) related to a member of staff (d) related to an elected member

Do any of these statements apply to you? [ ] Yes [ ] No

If Yes, please provide details of the name, relationship and role:

Date: 2015-04-02 08:54:48 9. Materials If applicable, please state what materials are to be used externally. Include type, colour and name for each material:

| Material Type | Existing (where applicable) | Proposed | Not applicable | Don't Know | |-------------------------------|-----------------------------|----------|----------------|------------| | Walls | SEE REFERENCE 1B | | | | | Roof | SEE REFERENCE 1B | | | | | Windows | SEE REFERENCE 1B | | | | | Doors | | | | | | Boundary treatments | | | | | | Vehicle access and hard-standing | | | | | | Lighting | | | | | | Others (please specify) | | | | |

Are you supplying additional information on submitted plan(s)/drawing(s)/design and access statement? [ ] Yes [ ] No

If Yes, please state references for the plan(s)/drawing(s)/design and access statement:

DESIGN AND ACCESS STATEMENT REF. 1C BLOCK PLAN REF. 1D EXISTING ELEVATIONS REF. 1G CURRENT FLOOR PLAN REF. 1E PROPOSED FLOOR PLAN REF. 1F PROPOSED ALTERATIONS REF. 1H PHOTOS - REF. 1J

10. Vehicle Parking Please provide information on the existing and proposed number of on-site parking spaces:

| Type of Vehicle | Total Existing | Total proposed (including spaces retained) | Difference in spaces | |------------------------------------------|----------------|--------------------------------------------|----------------------| | Cars | 5 owners | 5 owners | NONE | | Light goods vehicles/public carrier vehicles | | | | | Motorcycles | | | | | Disability spaces | | | | | Cycle spaces | | | | | Other (e.g. Bus) | | | | | Other (e.g. Bus) | | | | 11. Foul Sewage Please state how foul sewage is to be disposed of:

- [ ] Mains sewer
- [ ] Cess pit
- [ ] Septic tank
- [ ] Other
- [ ] Package treatment plant

Are you proposing to connect to the existing drainage system?

- [ ] Yes
- [ ] No

If Yes, please include the details of the existing system on the application drawings and state references for the plan(s)/drawing(s):

NO CHANGES TO EXISTING SEWAGE DISPOSAL

12. Assessment of Flood Risk Is the site within an area at risk of flooding? (Refer to the Environment Agency's Flood Map showing flood zones 2 and 3 and consult Environment Agency standing advice and your local planning authority requirements for information as necessary.)

- [ ] Yes
- [ ] No

If Yes, you will need to submit a Flood Risk Assessment to consider the risk to the proposed site.

Is your proposal within 20 metres of a watercourse (e.g. river, stream or beck)?

- [ ] Yes
- [ ] No

Will the proposal increase the flood risk elsewhere?

- [ ] Yes
- [ ] No

How will surface water be disposed of?

- [ ] Sustainable drainage system
- [ ] Existing watercourse
- [ ] Soakaway
- [ ] Pond/lake
- [ ] Main sewer

13. Biodiversity and Geological Conservation To assist in answering the following questions refer to the guidance notes for further information on when there is a reasonable likelihood that any important biodiversity or geological conservation features may be present or nearby and whether they are likely to be affected by your proposals.

Having referred to the guidance notes, is there a reasonable likelihood of the following being affected adversely or conserved and enhanced within the application site, or on land adjacent to or near the application site?

a) Protected and priority species:

- [ ] Yes, on the development site
- [ ] Yes, on land adjacent to or near the proposed development
- [ ] No

b) Designated sites, important habitats or other biodiversity features:

- [ ] Yes, on the development site
- [ ] Yes, on land adjacent to or near the proposed development
- [ ] No

c) Features of geological conservation importance:

- [ ] Yes, on the development site
- [ ] Yes, on land adjacent to or near the proposed development
- [ ] No

14. Existing Use Please describe the current use of the site:

DWELLING HOUSE WITH 3 BEDROOM ACCOMMODATION FOR BED AND BREAKFAST USE

Is the site currently vacant?

- [ ] Yes
- [ ] No

If Yes, please describe the last use of the site:

When did this use end (if known)?

DD/MM/YYYY

(date where known may be approximate)

Does the proposal involve any of the following?

- [ ] Yes
- [ ] No

If yes, you will need to submit an appropriate contamination assessment with your application.

Land which is known to be contaminated?

- [ ] Yes
- [ ] No

Land where contamination is suspected for all or part of the site?

- [ ] Yes
- [ ] No

A proposed use that would be particularly vulnerable to the presence of contamination?

- [ ] Yes
- [ ] No

15. Trees and Hedges Are there trees or hedges on the proposed development site?

- [ ] Yes
- [ ] No

And/or: Are there trees or hedges on land adjacent to the proposed development site that could influence the development or might be important as part of the local landscape character?

- [ ] Yes
- [ ] No

If Yes to either or both of the above, you may need to provide a full Tree Survey, at the discretion of your local planning authority. If a Tree Survey is required, this and the accompanying plan should be submitted alongside your application. Your local planning authority should make clear on its website what the survey should contain, in accordance with the current 'BS5837: Trees in relation to design, demolition and construction - Recommendations'.

16. Trade Effluent Does the proposal involve the need to dispose of trade effluents or waste?

- [ ] Yes
- [ ] No

If Yes, please describe the nature, volume and means of disposal of trade effluents or waste. 17. Residential Units (Including Conversion)

Does your proposal include the gain, loss or change of use of residential units? □ Yes □ No

If Yes, please complete details of the changes in the tables below:

| Proposed Housing | Existing Housing | |------------------|------------------| | **Market Housing** | **Not known** | **Number of Bedrooms** | **Total** | **Market Housing** | **Not known** | **Number of Bedrooms** | **Total** | | Houses | □ | 1 | 2 | 3 | 4+ | Unknown | Houses | □ | 1 | 2 | 3 | 4+ | Unknown | | Flats and maisonettes | □ | 1 | 2 | 3 | 4+ | Unknown | Flats and maisonettes | □ | 1 | 2 | 3 | 4+ | Unknown | | Live-work units | □ | 1 | 2 | 3 | 4+ | Unknown | Live-work units | □ | 1 | 2 | 3 | 4+ | Unknown | | Cluster flats | □ | 1 | 2 | 3 | 4+ | Unknown | Cluster flats | □ | 1 | 2 | 3 | 4+ | Unknown | | Sheltered housing | □ | 1 | 2 | 3 | 4+ | Unknown | Sheltered housing | □ | 1 | 2 | 3 | 4+ | Unknown | | Bedsit/studios | □ | 1 | 2 | 3 | 4+ | Unknown | Bedsit/studios | □ | 1 | 2 | 3 | 4+ | Unknown | | Unknown type | □ | 1 | 2 | 3 | 4+ | Unknown | Unknown type | □ | 1 | 2 | 3 | 4+ | Unknown |

**Totals (a+b+c+d+e+f+g) =**

| Social Rented | **Not known** | **Number of Bedrooms** | **Total** | **Social Rented** | **Not known** | **Number of Bedrooms** | **Total** | |----------------|----------------|------------------------|----------|------------------|----------------|------------------------|----------| | Houses | □ | 1 | 2 | 3 | 4+ | Unknown | Houses | □ | 1 | 2 | 3 | 4+ | Unknown | | Flats and maisonettes | □ | 1 | 2 | 3 | 4+ | Unknown | Flats and maisonettes | □ | 1 | 2 | 3 | 4+ | Unknown | | Live-work units | □ | 1 | 2 | 3 | 4+ | Unknown | Live-work units | □ | 1 | 2 | 3 | 4+ | Unknown | | Cluster flats | □ | 1 | 2 | 3 | 4+ | Unknown | Cluster flats | □ | 1 | 2 | 3 | 4+ | Unknown | | Sheltered housing | □ | 1 | 2 | 3 | 4+ | Unknown | Sheltered housing | □ | 1 | 2 | 3 | 4+ | Unknown | | Bedsit/studios | □ | 1 | 2 | 3 | 4+ | Unknown | Bedsit/studios | □ | 1 | 2 | 3 | 4+ | Unknown | | Unknown type | □ | 1 | 2 | 3 | 4+ | Unknown | Unknown type | □ | 1 | 2 | 3 | 4+ | Unknown |

**Totals (a+b+c+d+e+f+g) =**

| Intermediate | **Not known** | **Number of Bedrooms** | **Total** | **Intermediate** | **Not known** | **Number of Bedrooms** | **Total** | |---------------|----------------|------------------------|----------|------------------|----------------|------------------------|----------| | Houses | □ | 1 | 2 | 3 | 4+ | Unknown | Houses | □ | 1 | 2 | 3 | 4+ | Unknown | | Flats and maisonettes | □ | 1 | 2 | 3 | 4+ | Unknown | Flats and maisonettes | □ | 1 | 2 | 3 | 4+ | Unknown | | Live-work units | □ | 1 | 2 | 3 | 4+ | Unknown | Live-work units | □ | 1 | 2 | 3 | 4+ | Unknown | | Cluster flats | □ | 1 | 2 | 3 | 4+ | Unknown | Cluster flats | □ | 1 | 2 | 3 | 4+ | Unknown | | Sheltered housing | □ | 1 | 2 | 3 | 4+ | Unknown | Sheltered housing | □ | 1 | 2 | 3 | 4+ | Unknown | | Bedsit/studios | □ | 1 | 2 | 3 | 4+ | Unknown | Bedsit/studios | □ | 1 | 2 | 3 | 4+ | Unknown | | Unknown type | □ | 1 | 2 | 3 | 4+ | Unknown | Unknown type | □ | 1 | 2 | 3 | 4+ | Unknown |

**Totals (a+b+c+d+e+f+g) =**

| Key worker | **Not known** | **Number of Bedrooms** | **Total** | **Key worker** | **Not known** | **Number of Bedrooms** | **Total** | |------------|----------------|------------------------|----------|----------------|----------------|------------------------|----------| | Houses | □ | 1 | 2 | 3 | 4+ | Unknown | Houses | □ | 1 | 2 | 3 | 4+ | Unknown | | Flats and maisonettes | □ | 1 | 2 | 3 | 4+ | Unknown | Flats and maisonettes | □ | 1 | 2 | 3 | 4+ | Unknown | | Live-work units | □ | 1 | 2 | 3 | 4+ | Unknown | Live-work units | □ | 1 | 2 | 3 | 4+ | Unknown | | Cluster flats | □ | 1 | 2 | 3 | 4+ | Unknown | Cluster flats | □ | 1 | 2 | 3 | 4+ | Unknown | | Sheltered housing | □ | 1 | 2 | 3 | 4+ | Unknown | Sheltered housing | □ | 1 | 2 | 3 | 4+ | Unknown | | Bedsit/studios | □ | 1 | 2 | 3 | 4+ | Unknown | Bedsit/studios | □ | 1 | 2 | 3 | 4+ | Unknown | | Unknown type | □ | 1 | 2 | 3 | 4+ | Unknown | Unknown type | □ | 1 | 2 | 3 | 4+ | Unknown |

**Totals (a+b+c+d+e+f+g) =**

**Total proposed residential units (A+B+C+D) =**

**Total existing residential units (E+F+G+H) =**

**TOTAL NET GAIN or LOSS of RESIDENTIAL UNITS (Proposed Housing Grand Total - Existing Housing Grand Total):** 18. All Types of Development: Non-residential Floorspace

Does your proposal involve the loss, gain or change of use of non-residential floorspace? □ Yes □ No

If you have answered Yes to the question above please add details in the following table:

| Use class/type of use | Not applicable | Existing gross internal floorspace (square metres) | Gross internal floorspace to be lost by change of use or demolition (square metres) | Total gross internal floorspace proposed (including change of use)(square metres) | Net additional gross internal floorspace following development (square metres) | |-----------------------|----------------|---------------------------------------------------|---------------------------------------------------------------------------------|---------------------------------------------------------------------------------|--------------------------------------------------------------------------------| | A1 Shops | | | | | | | A2 Financial and professional services | | | | | | | A3 Restaurants and cafes | | | | | | | A4 Drinking establishments | | | | | | | A5 Hot food takeaways | | | | | | | B1 (a) Office (other than A2) | | | | | | | B1 (b) Research and development | | | | | | | B1 (c) Light industrial | | | | | | | B2 General industrial | | | | | | | B8 Storage or distribution | | | | | | | C1 Hotels and halls of residence | | | | | | | C2 Residential institutions | | | | | | | D1 Non-residential institutions | | | | | | | D2 Assembly and leisure | | | | | | | OTHER | | | | | | | Please Specify | | | | | | | Total | | | | | |

In addition, for hotels, residential institutions and hostels, please additionally indicate the loss or gain of rooms

| Use class | Type of use | Not applicable | Existing rooms to be lost by change of use or demolition | Total rooms proposed (including changes of use) | Net additional rooms | |-----------|-------------|----------------|----------------------------------------------------------|-------------------------------------------------|----------------------| | C1 Hotels | | X | NONE | ONE - TO CREATE | ONE | | C2 Residential institutions | | | OFFICE SPACE / STORAGE | | | | OTHER | | | SECOND SITTING AREA | | | | Please Specify | | | FOR OWNERS ONLY | | |

19. Employment

Please complete the following information regarding employees:

| Existing employees | Full-time | Part-time | Total full-time equivalent | |---------------------|-----------|-----------|---------------------------| | Proposed employees | NONE | NONE | NONE |

20. Hours of Opening

If known, please state the hours of opening (e.g. 15:30) for each non-residential use proposed:

| Use | Monday to Friday | Saturday | Sunday and Bank Holidays | Not known | |-----|------------------|----------|--------------------------|-----------| | BEYOND BREAKFAST - OPEN FOR BUSINESS ALL YEAR | | | | | | UNLESS OWNERS ON HOLIDAY | | | | |

21. Site Area

Please state the site area in hectares (ha) 0.0013 22. Industrial or Commercial Processes and Machinery

Please describe the activities and processes which would be carried out on the site and the end products including plant, ventilation or air conditioning. Please include the type of machinery which may be installed on site:

Is the proposal a waste management development? □ Yes □ No

If the answer is Yes, please complete the following table:

| Process Type | Not applicable | The total capacity of the void in cubic metres, including engineering surcharge and making no allowance for cover or restoration material (or tonnes if solid waste or litres if liquid waste) | Maximum annual operational throughput in tonnes (or litres if liquid waste) | |--------------------------------------------------|----------------|---------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------| | Inert landfill | | | | | Non-hazardous landfill | | | | | Hazardous landfill | | | | | Energy from waste incineration | | | | | Other incineration | | | | | Landfill gas generation plant | | | | | Pyrolysis/gasification | | | | | Metal recycling site | | | | | Transfer stations | | | | | Material recovery/recycling facilities (MRFs) | | | | | Household civic amenity sites | | | | | Open windrow composting | | | | | In-vessel composting | | | | | Anaerobic digestion | | | | | Any combined mechanical, biological and/or thermal treatment (MBT) | | | | | Sewage treatment works | | | | | Other treatment | | | | | Recycling facilities construction, demolition and excavation waste | | | | | Storage of waste | | | | | Other waste management | | | | | Other developments | | | |

Please provide the maximum annual operational throughput of the following waste streams:

| Waste Stream | Municipal | Construction, demolition and excavation | Commercial and industrial | Hazardous | |-------------------------------|-----------|------------------------------------------|---------------------------|-----------|

If this is a landfill application you will need to provide further information before your application can be determined. Your waste planning authority should make clear what information it requires on its website.

23. Hazardous Substances

Does the proposal involve the use or storage of any of the following materials in the quantities stated below? □ Yes □ No □ Not applicable

If Yes, please provide the amount of each substance that is involved:

| Substance | Amount (tonnes) | |----------------------------|-----------------| | Acrylonitrile (tonnes) | | | Ethylene oxide (tonnes) | | | Phosgene (tonnes) | | | Ammonia (tonnes) | | | Hydrogen cyanide (tonnes) | | | Sulphur dioxide (tonnes) | | | Bromine (tonnes) | | | Liquid oxygen (tonnes) | | | Flour (tonnes) | | | Chlorine (tonnes) | | | Liquid petroleum gas (tonnes) | | | Refined white sugar (tonnes) | | | Other: | | | Amount (tonnes): | | | Other: | | | Amount (tonnes): | | 24. Ownership Certificates and Agricultural Land Declaration (continued)

CERTIFICATE OF OWNERSHIP - CERTIFICATE C

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14

certify/ The applicant certifies that:

- Neither Certificate A or B can be issued for this application
- All reasonable steps have been taken to find out the names and addresses of the other owners\* and/or agricultural tenants\*\* of the land or building, or of a part of it, but I have/ the applicant has been unable to do so.

* "owner" is a person with a freehold interest or leasehold interest with at least 7 years left to run.

\*\* "agricultural tenant" has the meaning given in section 65(8) of the Town and Country Planning Act 1990

The steps taken were:

| Name of Owner / Agricultural Tenant | Address | Date Notice Served | |-------------------------------------|---------|--------------------| | | | | | | | | | | | | | | | |

Notice of the application has been published in the following newspaper (circulating in the area where the land is situated):

On the following date (which must not be earlier than 21 days before the date of the application):

Signed - Applicant: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Or signed - Agent: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CERTIFICATE OF OWNERSHIP - CERTIFICATE D

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14

certify/ The applicant certifies that:

Certificate A cannot be issued for this application

All reasonable steps have been taken to find out the names and addresses of everyone else who, on the day 21 days before the date of this application, was the owner\* and/or agricultural tenant\*\* of any part of the land to which this application relates, but I have/ the applicant has been unable to do so.

- "owner" is a person with a freehold interest or leasehold interest with at least 7 years left to run.

\*\* "agricultural tenant" has the meaning given in section 65(8) of the Town and Country Planning Act 1990

The steps taken were:

Notice of the application has been published in the following newspaper (circulating in the area where the land is situated):

On the following date (which must not be earlier than 21 days before the date of the application):

Signed - Applicant: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Or signed - Agent: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date (DD/MM/YYYY): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

25. Planning Application Requirements - Checklist

Please read the following checklist to make sure you have sent all the information in support of your proposal. Failure to submit all information required will result in your application being deemed invalid. It will not be considered valid until all information required by the Local Planning Authority has been submitted.

The original and 3 copies of a completed and dated application form: ☒

The original and 3 copies of the plan which identifies the land to which the application relates drawn to an identified scale and showing the direction of North: ☒

The original and 3 copies of other plans and drawings or information necessary to describe the subject of the application: ☒

The correct fee: ☒

The original and 3 copies of a design and access statement, if required (see help text and guidance notes for details): ☒

The original and 3 copies of the completed, dated Ownership Certificate (A, B, C or D – as applicable) and Article 14 Certificate (Agricultural Holdings): ☒ 24. Ownership Certificates and Agricultural Land Declaration

One Certificate A, B, C, or D, must be completed with this application form

CERTIFICATE OF OWNERSHIP - CERTIFICATE A

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14

I certify/The applicant certifies that on the day 21 days before the date of this application nobody except myself/ the applicant was the owner\* of any part of the land or building to which the application relates, and that none of the land to which the application relates is, or is part of, an agricultural holding\*\*

NOTE: You should sign Certificate B, C or D, as appropriate, if you are the sole owner of the land or building to which the application relates but the land is, or is part of, an agricultural holding.

- "owner" is a person with a freehold interest or leasehold interest with at least 7 years left to run. \*\* "agricultural holding" has the meaning given by reference to the definition of "agricultural tenant" in section 65(8) of the Act.

| Name of Owner / Agricultural Tenant | Address | Date Notice Served | |-------------------------------------|---------|--------------------| | | | | | | | | | | | | | | | |

Signed - Applicant: [Signature]

Or signed - Agent: [Signature]

Date (DD/MM/YYYY): 01/10/2015

CERTIFICATE OF OWNERSHIP - CERTIFICATE B

Town and Country Planning (Development Management Procedure) (England) Order 2015 Certificate under Article 14

I certify/The applicant certifies that I have/the applicant has given the requisite notice to everyone else (as listed below) who, on the day 21 days before the date of this application, was the owner\* and/or agricultural tenant\*\* of any part of the land or building to which this application relates.

- "owner" is a person with a freehold interest or leasehold interest with at least 7 years left to run. \*\* "agricultural tenant" has the meaning given in section 65(8) of the Town and Country Planning Act 1990

| Name of Owner / Agricultural Tenant | Address | Date Notice Served | |-------------------------------------|---------|--------------------| | | | | | | | | | | | | | | | |

Signed - Applicant: [Signature]

Or signed - Agent: [Signature]

Date (DD/MM/YYYY): [Blank]